マクログロブリン血症を呈した空腸リンパ肉腫の1例

A Case of Jejunal Lymphosarcoma Associated with Macroglobulinemia

　消化管の悪性腫瘍は癌腫の頻度が圧倒的に高く，悪性リンパ腫は1～4％で比較的稀な疾患とされている¹⁾．なかでも，小腸悪性リンパ腫は本邦においては胃に比し更に少く²⁾，特有な臨床症状を欠くために，偶然発見されるか，あるいは巨大腫瘤を触知せるために開腹され，はじめて確認される場合が少くない．

　筆者らは下血をもって来院し，小腸X線像より悪性リンパ腫を疑い，手術によりリンパ肉腫であることを確認し得た1例を経験した．

　The patient was a 56 years old male. In September 1971 he developed melena and was found to be anemic. In December of the same year, melena occurred again and his hemoglobin was down to 3.5 gram/dl. He was then admitted to the hospital for evaluation. Upper G-Ⅰ series revealed normal stomach, but barium studies of the small bowel repeatedly demonstrated segmental dilatation of the jejunum with loss of normal mucosal pattern. Many atypical lymphocytes and plasmacytoid cells were present on peripheral blood smear. And there was a striking increase of serum IgM (up to 1000 mg/dl), which was shown to be monoclonal on immuno-electrophoresis. Splenomegaly was thought to be present on palpation, which was later confirmed on radioisotope splenic scintiscan.

　Possibility of lympho-reticular malignancy of the small bowel, i. e. either lymphosarcoma or reticulum cell sarcoma, was strongly considered and laparotomy was performed. At the time of surgery, there was seen a neoplastic involvement of a segment of the jejunum, approximately 10 cm in length. The lumen of this segment was dilated and its mucosal surface had hemorrhagic ulcerations. Histologically, there was diffuse lymphoid infiltration of the submucosal layer, and the pathological diagnosis was lymphosarcoma.

　The patient received chemotherapy for lymphsarcoma before and after the surgery. The postoperative course was uneventful except that he developed transfusion hepatitis, from which he recovered readily. He is now back to his work.

　Lymphosarcoma occurring in jejunum is a rare condition. And its preoperative radiological diagnosis is often difficult if not impossible. Association of macroglobulinemia seen in this patient adds another point of interest.